Surprise Medical Bills: How the No Surprises Act Protects You

You can do everything right, go to an in-network hospital, and still be treated by someone outside your plan's network: an emergency room doctor, an anesthesiologist, an air ambulance crew. The No Surprises Act, a federal law that took effect on January 1, 2022, according to CMS, protects people from many of the unexpected out-of-network bills that can follow.

The law does two main things. If you use health insurance, it limits what you can be charged for certain out-of-network care to your plan's in-network cost sharing. If you do not have insurance or choose not to use it, it gives you the right to a good faith estimate and a way to dispute a bill that runs well over that estimate.

This guide summarizes the federal protections as CMS describes them as of October 2026. It is general information, not legal or insurance advice. Some states have additional protections, so your state insurance department is also worth a call if something looks wrong.

What the law covers if you have insurance

CMS says the No Surprises Act protects you from unexpected out-of-network bills for:

• Emergency room visits, including freestanding emergency departments.
• Non-emergency care related to a visit to an in-network hospital, hospital outpatient department or ambulatory surgical center.
• Air ambulance services.

These protections apply if you have coverage through an employer (including a Federal Employees Health Benefits plan), the federal Health Insurance Marketplace, a State-based Marketplace or other individual market coverage.

In an emergency, if your plan covers emergency care, the hospital, the providers treating you there and an air ambulance provider cannot charge you more than your plan's in-network cost-sharing rate. Cost sharing still applies, so you can owe your normal copayment, coinsurance or deductible. CMS notes that getting a bill before you meet your deductible is not a violation of the law.

For planned care, the protection covers situations like this one from CMS: your local hospital is in network, but an attending physician is not. Those protections do not extend to other settings, such as a doctor's office that is not a hospital outpatient department, or to care at an out-of-network facility you chose.

What it does not cover

CMS lists several exceptions:

• Ground ambulance services generally are not covered by the law's billing protections, unless a state law has different rules.
• Vision-only and dental-only plans generally are not covered, though the protections may apply if those benefits are part of your health plan.
• Short-term limited duration plans and health care sharing ministry plans are not covered.
• Fixed indemnity plans, such as hospital indemnity insurance, are not covered.

Medicare, Medicaid, Indian Health Service, VA health care and TRICARE already protect enrollees from some unexpected out-of-network bills under their own rules.

Be careful with notice and consent forms

The law lets some out-of-network providers ask you to give up your protections in writing. CMS says signing a notice and consent form means you agree to out-of-network care and give up your surprise billing protections, and you will likely pay more. CMS's advice is direct: to save money and stay in network, don't sign the form.

The form must be given separately from other paperwork, not hidden inside it, and must include an estimate of what the out-of-network care might cost. CMS says you should not be asked to sign one:

• In the emergency room for emergency services.
• If no in-network provider at the facility can provide the non-emergency service.
• By assistant surgeons, hospitalists or intensivists.
• For emergency medicine, anesthesiology, pathology, radiology, neonatology, or diagnostic services including radiology and laboratory services.

If you do not sign, a provider may decline to give non-emergency care, and you may need to reschedule with an in-network provider.

If your doctor leaves your plan's network

As of October 2026, CMS says "continuing care patients" may be able to keep seeing their provider at in-network rates for up to 90 days after the provider leaves the plan's network. This includes people being treated for a serious and complex illness, receiving inpatient or institutional care, scheduled for non-elective surgery, pregnant and undergoing treatment, or terminally ill. Ask your provider and plan whether you qualify.

If you are uninsured or paying yourself

If you do not have insurance or are not using it, CMS says providers usually must give you a good faith estimate when you schedule care at least 3 business days in advance or when you ask for one. You will not get an estimate for emergency care. Each provider and facility gives its own estimate, so for a surgery you might request one from the surgeon and one from the hospital.

Keep the written estimate. As of October 2026, CMS describes the patient-provider dispute process this way:

• You may dispute a bill if a provider or facility charged at least $400 more than its good faith estimate.
• You must start within 120 calendar days of the initial bill.
• There is a $25 non-refundable administrative fee; if you win, the fee is deducted from what you owe the provider.
• While the dispute is pending, the provider cannot send the bill to collections or threaten to, and must pause collection if it already has.

What to do when a surprise bill arrives

1. Do not pay right away. Compare the bill with the Explanation of Benefits from your insurer, which shows what the plan paid and what it says you owe.
2. Call the provider's billing office and ask whether the bill reflects in-network cost sharing under the No Surprises Act.
3. If the insurer denied or underpaid the claim, follow the appeal process in your plan's denial notice.
4. If you believe a provider, facility or insurer is not following the rules, submit a complaint to the No Surprises Help Desk at 1-800-985-3059 or online through CMS. Gather the bill, a photo of your insurance card, the Explanation of Benefits and any notice and consent form or good faith estimate.
5. If a debt collector contacts you about a surprise out-of-network bill, or one shows up on your credit report, CMS points you to the Consumer Financial Protection Bureau at 1-855-411-2372.

Watch for scams, too. The FTC warns that a bill or Explanation of Benefits for services you did not receive can be a sign of medical identity theft. Do not give your insurance or medical information to someone who calls, emails or texts you unexpectedly; contact your insurer or provider using a phone number or website you know is real.

For personal help, your state insurance department or Consumer Assistance Program can explain state protections that may add to the federal law.

Key takeaways

• The No Surprises Act, in effect since January 1, 2022, limits many out-of-network emergency, air ambulance and in-network-facility bills to in-network cost sharing.
• Ground ambulances, short-term plans, health care sharing ministries and fixed indemnity plans are outside its billing protections.
• You can decline to sign a notice and consent form, and certain providers, including anesthesiologists and ER providers, are not allowed to ask.
• If you are uninsured or self-paying, ask for a written good faith estimate; as of 2026, CMS says a bill at least $400 over it may be disputed within 120 days.
• Complaints go to the No Surprises Help Desk at 1-800-985-3059.

Sources

• CMS, The No Surprises Act protects people from unexpected medical bills
• CMS, Know your medical bill rights when using insurance
• CMS, Know your medical bill rights when not using insurance
• CMS, Dispute a medical bill
• CMS, Submit a provider or insurer complaint
• Federal Trade Commission, What To Know About Medical Identity Theft